Specialty Pharmaceuticals: The Data Customization Challenge

Author: Jim Maguire

Currently, most specialty pharmacies are integrated with and utilizing standard National Council for Prescription Drug Programs (NCPDP) transactions and data sets. These standards have been around for decades and all pharmacy-focused software and systems are fully integrated with and built around them.

In recent years, however, the increasing demands of payers, pharma, government regulations, data aggregators, and other health care stakeholders have more than outstripped the capabilities of the NCPDP transaction sets.

In addition, these requirements may not just alter the patient-centric data elements required to process an order, but can impact the entire pharmacy intake workflow— as demonstrated by the recent government implementation of REMS (Risk Evaluation and Mitigation Strategies). As a result of these frequent and complex changes, specialty pharmacy systems are often unable to meet the business’s requirements for functionality in the timeframes needed. A new software model is needed.

A potential solution is a specialtyfocused, flexible, rules-based pharmacy front-end application. Because pharmacies may shy away from replacing existing systems, the tool should have the capability to integrate with existing patient intake and dispensing systems. To help with product integration such as this, the software community has implemented a number of standards and methodologies. These include technologies such as SaaS (software as a service), SOA (service-oriented architecture), and XML (extensible markup language).

These programming tools allow applications to share and exchange data. Current pharmacy systems may utilize these technologies today to communicate such data elements as shipment tracking numbers, product inventory counts, dispensing status, or prescription image information. Given the mature nature of these integration and collaboration technologies, our industry may well be ready for the creation of a flexible, comprehensive, and scalable specialty pharmacy solution.

The tool will need to have configurable data entry forms and external interfaces, thus breaking down the barriers between pharmacy operations and software vendors or internal IT departments. The business needs to be able to react rapidly to changes in data requirements and process flows. Technical leads within the pharmacy operation will need the capability to create rules-based workflows. The business also needs the capability to add data elements and patient questions to electronic forms and assessments. The ability to rapidly add additional data requirements to an existing workflow will certainly provide any specialty pharmacy with a competitive advantage with manufacturers in the limited distribution arena.

Gathering the data is just part of the current problem. Our solution needs to be able to provide information back to providers, pharma, and payers in an automated and secure manner. A typical “gotcha” with many front-end systems is the use of free-form text boxes. Although freeform text boxes may make life easier during patient intake, they will cause serious issues when the data need to be extracted, reformatted, and sent to a manufacturer. As with other aspects of our solution, in order for pharmacies to remain competitive, the creation of manufacturer-specific extracts or plan-particular reports is something that needs to take place quickly and efficiently, while ensuring the highest level of quality.

Lastly, we should remember that our specialty pharmacy toolset needs to be mobile ready and HIPAA compliant. Today, it is not uncommon for doctors, patients, and nurses to be accessing applications from their iPhones, Androids, tablets, and other devices with Web browsers. Specialty pharmacies need to be able to deliver refill reminders, educational materials, prescription history, order status, and other critical patient-centric information cleanly, efficiently, and in HIPAAcompliant form to a variety of handheld devices. Having their systems mobile ready will provide a specialty pharmacy with a clear competitive advantage and help increase patient compliance and caregiver satisfaction.

Our industry has come a long way over the last 15 years; however, in our efforts to increase the quality of patient care while reducing overall health care costs, we need to continually move forward and embrace proven leading-edge technologies. Government regulators and business partners place heavy requirements on the specialty pharmacy industry—our systems need to be able to deliver on these demands. We also must be prepared to task ourselves on how these solutions are priced at fair market value and who pays for them…but that is another discussion.

Mr. Maguire is the CEO of Biomed Intelligence, a firm specializing in health care information technology support solutions. With over 20 years of experience, Mr. Maguire was formerly the chief information officer of a top pharmacy benefit manager and also led information technology operations at a top specialty pharmacy.